“I don’t think there’s necessarily a one size fits all” negotiating competing priorities in nurse shift scheduling: a qualitative study

Abstract

Background: the nursing workforce globally faces significant challenges, including burnout, stress, and absenteeism, exacerbated by unsafe staffing levels and suboptimal working conditions. In England, many nursing staff express intentions to leave their roles, driven by work-life imbalance. This study explores how the preferences and constraints of nursing staff, nurse managers, and hospital directors interact to influence shift scheduling decisions within the NHS, aiming to identify strategies that reconcile individual wellbeing with organisational imperatives.

Methods: this qualitative study employed framework analysis, guided by the Thomas-Kilmann Conflict Mode Instrument (TKI) to understand conflict management approaches in shift scheduling. Data were collected through semi-structured interviews with 17 nursing staff, five nurse managers, and six hospital directors across five diverse NHS Trusts in England. Interviews were conducted remotely, transcribed verbatim, and analysed to identify key themes and patterns.

Results: three primary themes were identified: Balancing Choice with Consistency, Predictability, and Flexibility; Adequate Rest and Recovery Between Shifts; and Enjoyment and Engagement at Work. The study found that collaborative and compromising conflict management approaches were most effective in preventing potential conflicts from escalating into actual conflicts. Flexible and predictable scheduling was crucial for enhancing nurse wellbeing and retention, while rigid policies often led to increased turnover and reduced morale. The study also highlighted the importance of considering external constraints, such as caring responsibilities, which can limit the effectiveness of workplace solutions.

Conclusions: effective nurse shift scheduling requires a blend of conflict management strategies, with an emphasis on collaborative and compromising approaches. By prioritising flexible scheduling and proactive communication, healthcare organisations can better support their nursing workforce, enhancing both individual wellbeing and organisational efficiency. These findings have significant implications for improving the sustainability and quality of healthcare service provision.

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Identifiers

ORCID for Hannah Ruth Barker: orcid.org/0000-0003-2639-3503

ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

ORCID for Chiara Dall'ora: orcid.org/0000-0002-6858-3535

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